MN 553 COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS GRADED A+
✔✔Iron replacements - ✔✔-Best taken on empty stomach with juice
-Dietary sources of iron: red meat, iron enriched breads/cereals, raisins, dark green
leafy vegetables, fish, poultry & eggs.
AE: N/V constipation, turns stool dark green/black.
Calcium decrease absorption, increase fluids+ fiber/stool softner.
Drug-drug interactions decrease absorb of tetracyclines, fluoroquinolones &
levothryroxine.
Do not take w/PPI, H2 receptor agonists=acidic stomach increases absorption.
Given w/juice to children provide a straw b/c it can stain teeth.
Fe dextran-IV (risk of anaphylaxis)
✔✔MMR - ✔✔**- 99% immunity after 2nd shot**
Monitoring
Laboratory monitoring is not necessary after MMR administration if the patient received
two age-appropriate doses of MMR. Rubella titer may be drawn to determine if a patient
is immune.
Pharmacodynamics
Immunization with MMR or measles vaccine alone stimulates the immune system to
produce disease-specific antibodies by inducing a subclinical infection with attenuated
virus particles. This subclinical infection is not contagious. The vaccine-induced
antibodies are capable of virus neutralization by complement activation, induction of
cell-mediated immunity, and opsonization. Measles and measles and rubella live virus
vaccine (M-R-Vax II) is the commonly used combined vaccine.
✔✔MMR Pharmacokinetics - ✔✔The MMR vaccine is administered subcutaneously
(SC). Antibodies are detectable 2 weeks after injection (rubella may take 2 to 6 weeks)
in 95% of patients vaccinated, and immunity occurs in about 10 days. Immunity persists
for 15 years or more, with permanent immunity developing in most patients. More than
99% of people who receive two doses of MMR separated by at least 1 month develop
evidence of immunity to measles, which is why the current recommendation is for two
doses. The effectiveness of two doses of MMR vaccine in preventing mumps ranges
from 31.5% to 95%, with a median effectiveness of 88%.
✔✔MMR Precautions & Contraindications - ✔✔-MMR contains live, attenuated virus,
and virus has been detected for 1 to 4 weeks after vaccination in the pharynx or nose of
most patients who receive the vaccine; however, this does not appear to cause virus
transmission.
, · According to the CDC (2013a), there are relatively few true contraindications to
administering MMR vaccine. They include previous anaphylactic reaction to the MMR
vaccine or any component of the vaccine, including neomycin (topically or systemically
administered) or gelatin. A history of contact dermatitis to neomycin is not a
contraindication to MMR. Anaphylactic reaction or hypersensitivity to eggs is no longer a
contraindication to MMR.
· Immunosuppression can potentiate virus production; therefore, MMR vaccination is not
recommended for immunocompromised patients.
· MMR vaccination is generally deferred if a patient has a moderate or severe febrile
illness and is given when the patient recovers from the acute phase of the illness. Minor
illnesses, with
✔✔MMR Adverse Drug Reactions - ✔✔· Fever, febrile seizure, thrombocytopenia.
· In times of mumps outbreak, a third dose of MMR has been administered with minimal
adverse effects, including injection site pain, redness and swelling, muscle or joint
aches and dizziness or light-headedness.
✔✔MMR · Drug Interactions - ✔✔· MMR should not be administered to patients
receiving immunosuppressants, including high-dose corticosteroids, interferon, and
antineoplastic drugs, because they may have insufficient response to immunization.
Inhaled corticosteroids are not a contraindication to MMR vaccine.
· The MMR vaccine may be inactivated by IG. To avoid inactivation of the attenuated
virus, administer the MMR vaccine at least 14 to 30 days before or 6 months after the
IG. If IG is being given in preparation for international travel, the MMR vaccine should
be administered at least 2 weeks before IG.
· MMR is not contraindicated if a PPD was done recently. PPD should be delayed for 4
to 6 weeks after an MMR has been given because it may interfere with the tuberculin
skin test, causing a temporary decrease in tuberculin skin sensitivity.
✔✔Chronic PPI - ✔✔Chronic use of PPI, pt may have Iron deficiency, anemia, B12 &
Calcium def.
· PPIs are antisecretory drugs used to treat gastric conditions characterized by
hyperacidity. They are used for erosive gastritis, GERD, and Zollinger-Ellison syndrome
and as part of a multidrug regimen for short-term treatment of active PUD, especially
duodenal ulcers caused by H. pylori.
✔✔PPI Pharmacodynamics - ✔✔· PPIs do not exhibit anticholinergic or histamine2-
blockade properties but suppress gastric acid secretion. These drugs reduce H+
secretion by inhibition of the H+/K+-ATPase enzyme system at the secretory surface of
the parietal cell itself to block the final step in H+ secretion. The effect is dose-related
AND SOLUTIONS GRADED A+
✔✔Iron replacements - ✔✔-Best taken on empty stomach with juice
-Dietary sources of iron: red meat, iron enriched breads/cereals, raisins, dark green
leafy vegetables, fish, poultry & eggs.
AE: N/V constipation, turns stool dark green/black.
Calcium decrease absorption, increase fluids+ fiber/stool softner.
Drug-drug interactions decrease absorb of tetracyclines, fluoroquinolones &
levothryroxine.
Do not take w/PPI, H2 receptor agonists=acidic stomach increases absorption.
Given w/juice to children provide a straw b/c it can stain teeth.
Fe dextran-IV (risk of anaphylaxis)
✔✔MMR - ✔✔**- 99% immunity after 2nd shot**
Monitoring
Laboratory monitoring is not necessary after MMR administration if the patient received
two age-appropriate doses of MMR. Rubella titer may be drawn to determine if a patient
is immune.
Pharmacodynamics
Immunization with MMR or measles vaccine alone stimulates the immune system to
produce disease-specific antibodies by inducing a subclinical infection with attenuated
virus particles. This subclinical infection is not contagious. The vaccine-induced
antibodies are capable of virus neutralization by complement activation, induction of
cell-mediated immunity, and opsonization. Measles and measles and rubella live virus
vaccine (M-R-Vax II) is the commonly used combined vaccine.
✔✔MMR Pharmacokinetics - ✔✔The MMR vaccine is administered subcutaneously
(SC). Antibodies are detectable 2 weeks after injection (rubella may take 2 to 6 weeks)
in 95% of patients vaccinated, and immunity occurs in about 10 days. Immunity persists
for 15 years or more, with permanent immunity developing in most patients. More than
99% of people who receive two doses of MMR separated by at least 1 month develop
evidence of immunity to measles, which is why the current recommendation is for two
doses. The effectiveness of two doses of MMR vaccine in preventing mumps ranges
from 31.5% to 95%, with a median effectiveness of 88%.
✔✔MMR Precautions & Contraindications - ✔✔-MMR contains live, attenuated virus,
and virus has been detected for 1 to 4 weeks after vaccination in the pharynx or nose of
most patients who receive the vaccine; however, this does not appear to cause virus
transmission.
, · According to the CDC (2013a), there are relatively few true contraindications to
administering MMR vaccine. They include previous anaphylactic reaction to the MMR
vaccine or any component of the vaccine, including neomycin (topically or systemically
administered) or gelatin. A history of contact dermatitis to neomycin is not a
contraindication to MMR. Anaphylactic reaction or hypersensitivity to eggs is no longer a
contraindication to MMR.
· Immunosuppression can potentiate virus production; therefore, MMR vaccination is not
recommended for immunocompromised patients.
· MMR vaccination is generally deferred if a patient has a moderate or severe febrile
illness and is given when the patient recovers from the acute phase of the illness. Minor
illnesses, with
✔✔MMR Adverse Drug Reactions - ✔✔· Fever, febrile seizure, thrombocytopenia.
· In times of mumps outbreak, a third dose of MMR has been administered with minimal
adverse effects, including injection site pain, redness and swelling, muscle or joint
aches and dizziness or light-headedness.
✔✔MMR · Drug Interactions - ✔✔· MMR should not be administered to patients
receiving immunosuppressants, including high-dose corticosteroids, interferon, and
antineoplastic drugs, because they may have insufficient response to immunization.
Inhaled corticosteroids are not a contraindication to MMR vaccine.
· The MMR vaccine may be inactivated by IG. To avoid inactivation of the attenuated
virus, administer the MMR vaccine at least 14 to 30 days before or 6 months after the
IG. If IG is being given in preparation for international travel, the MMR vaccine should
be administered at least 2 weeks before IG.
· MMR is not contraindicated if a PPD was done recently. PPD should be delayed for 4
to 6 weeks after an MMR has been given because it may interfere with the tuberculin
skin test, causing a temporary decrease in tuberculin skin sensitivity.
✔✔Chronic PPI - ✔✔Chronic use of PPI, pt may have Iron deficiency, anemia, B12 &
Calcium def.
· PPIs are antisecretory drugs used to treat gastric conditions characterized by
hyperacidity. They are used for erosive gastritis, GERD, and Zollinger-Ellison syndrome
and as part of a multidrug regimen for short-term treatment of active PUD, especially
duodenal ulcers caused by H. pylori.
✔✔PPI Pharmacodynamics - ✔✔· PPIs do not exhibit anticholinergic or histamine2-
blockade properties but suppress gastric acid secretion. These drugs reduce H+
secretion by inhibition of the H+/K+-ATPase enzyme system at the secretory surface of
the parietal cell itself to block the final step in H+ secretion. The effect is dose-related
